Central venous catheter insertion in critical illness: Techniques and complications
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Date
2018-04
Authors
Adekola, O. O
Irurhe, N. K
Raji, V. A
Desalu, I
Journal Title
Journal ISSN
Volume Title
Publisher
Woltlers Kluwer
Abstract
Background: Werner Forssman, in 1929, first described central venous catheter (CVC)
insertion when he canalized his own right atrium through the cephalic vein. It is now a routine
procedure in critical care. We investigated the pattern of insertion of CVC in our intensive care
unit. Patients and Methods: A prospective observational study conducted in a 5-bed general
intensive care unit of a 770-bed university teaching hospital. All prospective patients admitted
from January 2013 to June 2014 were recruited. The technique, site and complications following
insertion were documented. All had postprocedure chest radiography performed to confirm
catheter tip position. Results: The most common site and technique of CVC insertion were
the right internal jugular vein (IJV) 71 (79.8%), and the anatomic landmark (AL) 66 (74.2%),
respectively. The mean catheter depth was significantly shorter in the AL (15.0 ± 2.4) cm
than the Peres’ formula (16.5 ± 3) cm, P = 0.046. Catheter tips were correctly placed at the
carina in 62 (69.7%) patients. The complication rate was 28 (31.5%), which was significantly
higher in males 25 (45.5%) than females 3 (8.9%), P = 0.03, and increased by 57.9% with
attempts >2. The most common complications were failure to insert 9 (10.1%), right carotid
artery puncture (8.9%), and arrhythmias (5.9%). Pneumothorax was reported in (4.5%), all
occurred with the subclavian approach. Conclusion: Central venous catheter insertion is more
common through the right internal jugular vein, and with the anatomical landmark technique.
The complication increased with attempts >2, male gender, and subclavian approach.
Description
Scholarly article
Keywords
Carina , Central venous catheter , Critical illness , Technique , Research Subject Categories::MEDICINE::Surgery::Anaesthetics and intensive care
Citation
Adekola OO, Irurhe NK, Raji VA, Desalu I. Central venous catheter insertion in critical illness: Techniques and complications. J Clin Sci 2018;15:96-101.